• Archives of Plastic Surgery
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• v.45 no.5
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• pp.479-483
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• 2018

Malignant peripheral nerve sheath tumor (MPNST) is a very rare type of sarcoma, with an incidence of 0.001%. MPNST has a 5-year survival rate near 80%, so successful reconstruction techniques are important to ensure the patient's quality of life. Sarcoma of the forearm is known for its poor prognosis, which leads to wider excision, making reconstruction even more challenging due to the unique anatomical structure and delicate function of the forearm. A 44-year-old male presented with a large mass that had two aspects, measuring $9{\times}6cm$ and $7{\times}5cm$, on the dorsal aspect of the right forearm. The extensor compartment muscles (EDM, EDC, EIP, EPB, EPL, ECRB, ECRL, APL) and invaded radius were resected with the mass. Tendon transfer of the entire extensor compartment with skin defect coverage using a $24{\times}8cm$ anterolateral thigh (ALT) perforator free flap was performed. The patient was discharged after 18 days without wound complications, and has not complained of discomfort during supination, pronation, or wrist extension/flexion through 3 years of follow-up. To our knowledge, this is the first report of successful reconstruction of the entire forearm extensor compartment with ALT free flap coverage after resection of MPNST.

• Archives of Craniofacial Surgery
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• v.21 no.1
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• pp.35-40
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• 2020

Background: Extensive eyelid defects are extremely challenging to reconstruct. Although numerous procedures for reconstructing periorbital defects have been proposed, no method is universally used. However, the Tenzel flap is the most commonly used technique to reconstruct eyelid defects affecting one-third to two-thirds of the eyelid. Methods: Recognizing the usefulness of the Tenzel method, we adapted it to reconstruct larger defects around the eyes. Seven patients underwent reconstruction with a modified Tenzel flap with an extended concept after wide excision of a malignant skin lesion. The main difference from the conventional method is that the modified Tenzel flap includes the medial portion of the lower lid defect. The design of a modified Tenzel flap begins as a semicircle at the lateral canthal area, in the same way as a classical Tenzel flap, and extends medially along the subciliary line to cover the defect on the medial lower eyelid. The follow-up time ranged from 3 to 28 months. Results: All flaps survived and healed well, with minimal scarring and natural palpebral outlines. Conclusion: Compared to traditional procedures, the modified Tenzel flap has several advantages, including a one-stage operation, a less noticeable scar, and effective prevention of complications such as lower eyelid ectropion.

• Journal of Yeungnam Medical Science
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• v.29 no.2
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• pp.141-144
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• 2012

Membranous glomerulonephritis can manifest as a paraneoplastic syndrome. The presence of evidence that supports the relationship between malignancy and membranous glomerulonephritis remains unresolved, though. Membranous glomerulonephritis has been commonly reported as associated with solid or hematologic malignancy, such as lung cancer, prostate cancer, and gastro-intestinal cancer, but its concomitant existence with skin cancer is rare. This paper reports a case of membranous glomerulonephritis combined with basal cell carcinoma that was successfully treated with the excision of the basal skin cell carcinoma.

• Korean Journal of Head & Neck Oncology
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• v.32 no.1
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• pp.37-40
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• 2016

The pilomatricoma is a benign skin neoplasm arising from hair follicle matrix cells, and it comprises approximately 0.12% of all benign skin tumors. It occurs most commonly in head and neck. It usually tends to occur in childhood or school-age. Mainly, it exists in single subcutaneous or intradermal nodule and grows very slowly. The diagnosis is confirmed by histopathologic examination. Histopathologically, it is characterized by basaloid cells, enucleated shadow cells and calcifications in the shadow cell. However, it is rare to present extensive ossification in pilomatricoma. The treatment of choice is wide local excision. A 66-year-old man came to our clinic and he complained of two masses on right parotid tail and posterior neck. We performed excisional biopsy on posterior neck and partial parotidectomy. The pathology of former was pilomatricoma with extensive ossification. We report a rare unique case of pilomatricoma with brief review of literature.

• Archives of Plastic Surgery
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• v.45 no.1
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• pp.85-88
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• 2018

Local flaps exhibit excellent color matching that no other type of flap can compete with. Moreover, surgery using a local flap is easier and faster than surgery using a distant or free flap. However, local flaps can be much more difficult to design. We designed 2 templates to plan a V-Y rotation advancement flap. The template for a unilateral V-Y rotation advancement flap was used on the face (n=5), anterior tibia (n=1), posterior axilla (n=1), ischium (n=1), and trochanter (n=2). The template for a bilateral flap was used on the sacrum (n=8), arm (n=1), and anterior tibia (n=1). The causes of the defects were meningocele (n=3), a decubitus ulcer (n=5), pilonidal sinus (n=3), and skin tumor excision (n=10). The meningocele patients were younger than 8 days. The mean age of the adult patients was 50.4 years (range, 19-80 years). All the donor areas of the flaps were closed primarily. None of the patients experienced wound dehiscence or partial/total flap necrosis. The templates guided surgeons regarding the length and the placement of the incision for a V-Y rotation advancement flap according to the size of the wound. In addition, they could be used for the training of residents.

• Archives of Craniofacial Surgery
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• v.12 no.1
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• pp.67-70
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• 2011

Purpose: Epidermal nevi are hamartomas of the skin with multiple clinical variants. Normally, epidermal nevi present at an early age, are found on the head and neck area, and have a female predominance. Only very rarely do epidermal nevi have an adult onset. Most lesions are small and giant Epidermal nevi (> 5 cm at its greatest diameter) are quite rare. Huge verrucous plaque was observed on the scalp of a 70-year-old man. He had been reclusive for a long time, and this problem might have played a crucial role in the development of the giant epidermal nevi. Methods: A punch biopsy and MRI imaging were performed. The huge mass was resected. A local flap and split thickness skin graft was used for reconstruction. Results: The histology examination revealed the characteristic findings of epidermal nevus. Postoperatively, the patient did not suffer from complications or recurrence. Conclusion: A rare case of a huge epidermal nevus on the scalp of an elderly man was treated with a surgical excision. This is the oldest patient reported with an adult onset epidermal nevus in Korea.

• Archives of Plastic Surgery
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• v.48 no.1
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• pp.10-14
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• 2021

Soft tissue filler injections are widely used due to their immediate effects, predictable results, and high stability. However, as the use of soft tissue filler injections has increased, various complications have been reported. We report a life-threatening complication in a patient who developed sepsis and necrotizing fasciitis. A 45-year-old woman presented with right leg pain and discharge from the labia majora. The patient had received a soft tissue filler injection of unknown composition 1 year earlier and had recently undergone incision and drainage for an inflammatory cystic nodule. Antibiotic treatment was administered for cellulitis, but the infection progressed to necrotizing fasciitis and sepsis. Fasciotomy and intensive care unit treatment improved the systemic infection, but the soft tissue filler injection site did not respond to treatment for 1 month. Thus, the injection site was covered with a pedicled vertical rectus abdominis musculocutaneous flap after wide excision. The area of skin necrosis on the leg was covered with split-thickness skin grafts. Infections occurring after soft tissue filler injections are related to biofilms, and treatment is sometimes difficult. Therefore, although soft tissue filler injections have a favorable safety profile, it is important to be aware of the risk of life-threatening complications.

• Journal of Yeungnam Medical Science
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• v.40 no.4
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• pp.423-425
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• 2023

Porokeratosis ptychotropica is an uncommon form of porokeratosis, which was initially described in 1995. It is clinically characterized by symmetrical reddish to brown-colored hyperkeratotic, verrucous, or psoriasiform plaques on the perianal and gluteal regions. The lesions tend to integrate and expand centrally, with small peripheral satellite lesions. Early skin biopsy and appropriate diagnosis are essential because malignant change occurs in 7.5% of porokeratotic lesions. Conventional treatment options include topical steroid, retinoid, imiquimod, 5-fluorouracil, isotretinoin, excimer laser, photodynamic therapy, intralesional steroid or bleomycin injection, cryotherapy, carbon dioxide (CO₂) laser, and dermatome and excision, but none seem to achieve complete clearance. A 68-year-old woman presented with diffuse hyperkeratotic scaly lichenoid plaques on the buttocks that had persisted for several years. A skin biopsy of the buttocks revealed multiple cornoid lamellae and intense hyperkeratosis. There were some dyskeratotic cells beneath the cornoid lamellae and the granular layer was absent. Porokeratosis ptychotropica was diagnosed based on the characteristic clinical appearance and typical histopathological manifestations. She was treated with a CO₂ laser in one session and topical application of urea and imiquimod cream for 1 month. The lesions slightly improved at the 1-month follow-up. We herein present a rare case of porokeratosis ptychotropica.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.747-754
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• 2011

Purpose: The Abbe flap procedure has been used to correct disharmony of the upper and lower lips as well as for making a philtrum for patients with secondary cleft lip deformities. But the Abbe flap procedure adds two scars in addition to the prior operative scar on the upper lip. This study was conducted to determine the treatment outcomes of esthetic subunit excision of the scar on the philtrum and Abbe flap coverage for correction of cleft lip deformities with photogrammetric analysis. Methods: This study investigated a total of 11 patients with cleft lip deformities who underwent scar excision with Abbe flap coverage, and the patients were followed up for at least 6 months. Under general anesthesia, a mushroom-shaped Abbe flap was drawn on the lower lip with a width of 8 mm and a height 1~2 mm longer than that of the philtral midline. The epidermis and dermis of the scar on the upper lip were excised. In the cases with alar base depression, the orbicularis oris muscle was split vertically and transposed to the alar base. The Abbe flap was harvested as a pedicled flap containing a small amount of muscle and this was rotated 180-degree to be inserted into the upper lip. Mucosa, muscle, subcutaneous tissue and skin were closed in layers. The flap was divided at the 7~14 postoperative day. The postoperative outcomes were evaluated by using photogrammetric analysis. Three indices were measured from the standard clinical photographs taken before and after the surgery. For anthroposcopic assessment, observers described the postoperative outcomes using an ordinary scale method. Results: The postoperative values obtained in the photogrammetric analysis showed improvement as compared with the preoperative ones. Improved anthroposcopic outcomes were also noted. Conclusion: Scar excision and Abbe flap coverage were proven to be effective in improving protrusion and the height of the upper lip, the scar of the upper lip and the symmetry of Cupid's bow and the philtral column, as well as formation of the philtral dimple.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.13-18
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• 2010

Purpose: Nasal defect can be caused by excision of tumor, trauma, inflammation from foreign body reaction. Nose is located in the middle of face and protruded, reconstruction should be done in harmony with size, shape, color, and textures. We report various methods of nasal reconstruction using local flaps. Methods: From March 1998 to July 2008, 36 patients were operated to reconstruct the nasal defects. Causes of the nasal defects were tumor (18 cases), trauma (11 cases), inflammation from foreign body reaction (5 cases) and congenital malformation (2 cases). The sites of the defects were ala (22 cases), nasal tip (8 cases) and dorsum (6 cases). The thickness of the defects was skin only (5 cases), dermis and cartilagenous layer (7 cases) and full-thickness (24 cases). According to the sites and thickness of the defects, various local flaps were used. Most of alar defects were covered by nasolabial flaps or bilobed flaps and the majority of dorsal and tip defects were covered by paramedian forehead flaps. Small defects below $0.25 cm^2$ were covered with composite graft or full-thickness skin graft. Results: The follow-up period was 14 months. Partial flap necrosis was observed in a case, and one case of infection was reported, it was improved by wound revision and antibiotics. Nasal reconstruction with various local flaps could provide satisfactory results in terms of color and texture match. Conclusion: The important factors of nasal reconstruction are the shape of reconstructed nose, color, and texture. Nasolabial flap is appropriate method for alar or columellar reconstruction and nasolabial island flap is suitable for tip defect. The defect located lateral wall could be reconstructed with bilobed flap for natural color and texture. Skin graft should be considered when the defect could not afford to be covered by adjacent local flap. And entire nasal defect or large defect could be reconstructed by paramedian forehead flap.